| NPI | 1366460685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007719-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4603) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-02-09 |